Author: Jason Curtis

What are neighbourhood care teams?

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Neighbourhood care teams are a specific example of integrated care.

These are usually local teams comprising health and social care professionals, sometimes supported by housing professionals or the voluntary sector, that work with people with long-term or multiple conditions or the frail elderly. The service user usually has access to a case worker or navigator for a single point of access, medical records are usually shared between the members of the team, and members of the team may be drawn from different organisations. Their aim is to support people to remain in their own homes and live as independently as possible, and to avoid unnecessary hospital admissions.

They may also be known as integrated local care teams, locality care teams, virtual wards, neighbourhood teams or similar. Neighbourhood care teams or similar models are a feature of many local Sustainability and Transformation Plans (STPs).

What examples are there of neighbourhood care teams in practice?

The document from NHS England on new care models (1) provides examples of a couple of schemes similar to neighbourhood care teams, namely Fylde Coast Local Health Economy and Stockport Together.

Other examples include:

What’s the evidence for neighbourhood care teams?

A Nuffield Trust report (2) looking at different community interventions including integrated health and social care teams found no evidence of a reduction in hospital admissions, but this may be due to ‘case finding’ identifying previous unmet needs, and any reduction in admissions may only happen in the long-term.

However, there is evidence (3) that co-ordination of care through integrated teams improves patient experience and quality of life, and some evidence that chronic care management models are associated with lower costs.

Further reading

  1. NHS England (2016). New care models: Vanguards – developing a blueprint for the future of NHS and care services https://www.england.nhs.uk/wp-content/uploads/2015/11/new_care_models.pdf
  2. Nuffield Trust (2011). An evaluation of the impact of community-based interventions on hospital use https://www.nuffieldtrust.org.uk/files/2017-01/evaluation-community-based-interventions-hospital-use-report-web-final.pdf
  3. King’s Fund (2015). Care co-ordination through integrated health and social care teamshttps://www.kingsfund.org.uk/projects/gp-commissioning/ten-priorities-for-commissioners/care-coordination

What is social prescribing?

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Social prescribing is a means for GPs and other primary care professionals to refer patients to non-medical interventions that can be used to improve their physical or mental well-being. The kinds of options available for prescribing could include walking groups, knit and natter groups, cookery classes, adult learning, volunteering, and self-help reading (the Books on Prescription scheme is an example of social prescribing).

Social prescribing is mentioned in the NHS England document ‘Next Steps on the Five Year Forward View’ and in the General Practice Forward View as a means of reducing avoidable demand, with an aim to work with the voluntary sector and primary care to ‘design a common approach to self-care and social prescribing’. A national clinical champion for social prescribing was appointed by NHS England in 2016.

Social prescribing is a feature of many local Sustainability and Transformation Plans (STPs), including the one for Shropshire and Telford & Wrekin.

What examples are there of social prescribing in practice?

There are plenty of examples, some of which are listed in the evaluation carried out by the University of York on pages 5-7. The Commissioning Handbook for Librarians provides suggestions for searching for material about social prescribing which will help identify more.

The Rotherham social prescribing service is a very large scheme, and was mentioned in the NHS Five Year Forward View as an emerging model for the future.

What's the evidence for social prescribing?

A systematic review carried out in 2016 and published in BMJ Open found that there was there was little good quality systematic evidence to inform the commissioning of social prescribing programmes, as did a previous review of 2015 published by the University of York’s Centre for Reviews and Dissemination.

There is some evidence that social prescribing schemes can make a difference to outcomes such as quality of life, levels of depression, and reduction in use of health services, and social prescribing schemes show high levels of satisfaction from users and health care professionals. However, much of the evidence is qualitative, is from self-reported outcomes, and is from small-scale schemes. Most studies focus on a particular intervention rather than social prescribing generally. Evidence on the cost-effectiveness of social prescribing is limited.

Searching for qualitative studies in CINAHL

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Qualitative research can help to understand the human experience of health and illness, and is an important part of evidence-based healthcare. Qualitative research can use various methods, such as grounded theory, phenomenology, or focus groups.

However, it is not always easy to identify qualitative studies in the literature.

Work has been done to create search strategies to locate these studies in the CINAHL database (covering nursing and allied health) and these can help to reduce the potential number of references to review.

If you're searching CINAHL using the NHS Healthcare Databases, this is an example strategy that can be copied and pasted into the search box:

exp ATTITUDE/ OR exp INTERVIEWS/ OR exp "QUALITATIVE STUDIES"/

Once the search is complete, carry out a search for your topic of interest, and then combine the searches together.

If you're searching CINAHL using EBSCOHost (either via OmniSearch, or using Staffordshire University resources), the strategy to use is:

(MH "Attitude+") OR (MH "Interviews+") OR (MH "Qualitative Studies+")

Copy and paste the strategy into the search box and run the search. Once the search is complete, carry out a search for your topic of interest, and then combine the searches together (you'll need to visit the search history to combine searches).

These searches are fairly 'sensitive' and will pick up most articles that are qualitative research, but will include some that are not. However, they will vastly reduce the number of non-qualitative research articles in your results and make it easier to find qualitative research.

Searching for Economic Evaluations in Healthcare

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Are you looking for information on the cost effectiveness of different treatments, or cost-benefit analyses? Published economic evaluations are a good place to start, but they're not always easy to find in the literature, so below are some suggestions for places to look and ways to search for them.

Once you've found an economic evaluation, you could use the CASP Economic Evaluation Checklist to critically appraise it.

CEA Registry

The CEA (Cost Effectiveness Analysis) Registry is a collection of over 5,500 articles containing cost-utility analyses.

NHS Economic Evaluation Database (NHS EED)

The NHS Economic Evaluation Database (EED) contains details of articles containing economic evaluations of healthcare interventions. It covers the period up to the end of 2014 (sadly, it is no longer being updated with new information)

It can be searched via the Cochrane Library, and results are shown in the 'Economic Evaluations' section of the results list.

Medline

Medline is a very comprehensive database, with coverage of all areas of medicine, including nursing, allied health, public health and mental health.

Economic evaluations can be found by using a search strategy such as this one for Medline:

(ec).fs OR (cost).ti OR exp *"HEALTH CARE COSTS"/ OR exp *"COSTS AND COST ANALYSIS"/

Copy and paste this into the search box and run the search, then carry out your subject search and combine the two. More strategies can be found on the McMaster University website but they will need to be adapted for the NHS databases.

EMBASE

Excepta Medica (EMBASE) covers all aspects of medicine, nursing, allied health, health policy, and public health. It is particularly strong on pharmaceutical information, and has an emphasis on European literature.

Economic evaluations can be found by using a search strategy such as this one for EMBASE:

exp *"COST EFFECTIVENESS ANALYSIS"/ OR exp *"ECONOMIC EVALUATION"/ OR (cost).ti OR (economic).ti,ab

Copy and paste this into the search box and run the search, then carry out your subject search and combine the two. More strategies can be found on the McMaster University website but they will need to be adapted for the NHS databases.

Developing People - Improving Care

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NHS Improvement recently published the paper Developing People - Improving Care Strategic Framework: A national framework for action on improvement and leadership development in NHS-funded services.

This strategy focuses on developing improvement skills and leadership capabilities in the NHS, and covers areas such as:

  • Systems leadership for staff who are working with partners in other local services
  • Quality improvement methods that draw on staff and service users’ knowledge and experience
  • Inclusive and compassionate leadership, so that all staff are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve
  • Talent management to support NHS-funded services to fill senior current vacancies and future leadership pipelines with the right numbers of diverse, appropriately developed people

The strategy will help the NHS to develop capability and capacity to deliver the Five Year Forward Plan and Sustainability and Transformation Plans (STPs).